Adverse pregnancy outcomes spell increased stroke risk

Women who have had adverse pregnancy outcomes are at high risk of early-onset cerebrovascular disease, according to a study.

For the study, researchers used the longitudinal Finnish nationwide health registry data from the FinnGen Study. A total of 144,306 women who gave birth after 1969, with a total of 316 789 births, were included in the analysis.

Adverse pregnancy outcomes included gestational hypertension, pre-eclampsia, eclampsia, preterm birth, small for gestational age infant, or placental abruption. Stroke, on the other hand, was defined as first hospital admission for ischaemic stroke or nontraumatic intracerebral or subarachnoid haemorrhage, excluding stroke during pregnancy or within 1 year postpartum.

Of the women, 17.9 percent had at least one pregnancy with an adverse outcome and 2.9 percent had ≥2 pregnancies with an adverse outcome. Women with vs without adverse pregnancy outcomes tended to have more comorbidities including obesity, hypertension, heart disease, and migraine.

Median age at first stroke was 58.3 years in women without any adverse pregnancy outcomes, 54.8 years in those with one occasion of adverse pregnancy outcomes, and 51.6 years in those with recurrent adverse pregnancy outcomes.

In multivariable Cox models, the risk of stroke was significantly greater in women with one adverse pregnancy outcomes (adjusted hazard ratio [aHR], 1.3, 95 percent confidence interval [CI], 1.2–1.4) and recurrent adverse pregnancy outcomes (aHR, 1.4, 95 percent CI, 1.2–1.7) compared with those who had none.

Of note, women with recurrent adverse pregnancy outcomes had about twofold increased risk of developing stroke before the age 45 years (adjusted odds ratio, 2.1, 95 percent CI, 1.5–3.1) compared with those without.